What is the most common lumbar MRI finding that correlates with an Annular Tear ?

In the very early days of MRI use to evaluate the lumbar spine, there were some findings that were thought to strongly correlate with low back pain. One such finding was the High Intensity Zone or HIZ. Dr Bogduk,a renowned Australian spine expert, was very enthusiastic to make the correlation between HIZ, annular tear and chronic recurring low back pain. He felt there was a very strong correlation but there wasn’t enough corroboration from others.

The white spot in the MRI indicated edema in an annular tear or injury but unfortunately it did not correlate well with back pain. In fact most patients with a high intensity zone (HIZ) seen in the MRI don’t have significant axial back pain.

So what MRI finding correlates best with an annular tear ?

The answer is a disc bulge.

The disc bulge is a common finding and is present to some degree in almost everyone over the age of 45. Since it is so common, it is rarely considered to have much significance. This is a big problem for people with chronic recurring low back pain. It also represents a tremendous opportunity to take the next step to make the correct diagnosis of an annular tear-by using a discogram followed by CT scan. Look for a disc bulge on the MRI of your next patient with chronic recurring low back pain, and do a discogram. Then follow the discogram immediately with a CT scan, you will be amazed at what you see and your view of chronic recurring low back pain will change forever.